Long-Term Effect of Hospital Pay for Performance on Mortality in England

In this analysis of the long-term effect of a pay-for-performance program introduced in England in 2008, in-hospital 30-day mortality for conditions linked to program incentives was reduced during the first 18 months, but the reduction was not sustained at 42 months. Pay-for-performance initiatives, which explicitly link financial incentives to the performance of health care providers, have been adopted in several countries in recent years. 1 , 2 These programs aim to improve the quality of care provided, which should result in better patient outcomes. However, evidence that improvements in health are realized in practice is currently lacking. 3 – 5 Few programs have been subjected to robust evaluation. Programs that have been evaluated show modest and short-term improvements at best on measures of processes related to financial incentives. 6 , 7 There is particular concern about the long-term effects of pay-for-performance initiatives, since initial improvements in measures . . .